Are the Government massaging the death rate.

I believe that the situation within care homes has been nothing short of a scandal. They have not been prioritised for the supply of PPE to their staff, have been almost totally excluded from the testing regime and their staff, who are amongst the lowest paid and most overworked in the country, have basically been left to muddle through as best they can. In many ways it has put into sharp focus how our social care system is very much the Cinderella service when it comes to health care in this country.

However, the one area where I do have some sympathy with the Government is on the timely reporting of deaths within a care home setting. It is incredibly difficult to see how an accurate and robust system could be introduced that would enable such deaths to be included within the figures published daily by the Department of Health and Social Care (DHSC).

The figures currently published daily are a count of those who have tested positive for Covid-19, who have then subsequently died within hospital. As a result, we know for certain that all of those individuals actually had Covid-19, we know that they were suffering severe symptoms as a result (because our testing regime only tests individuals who meet that criteria) and we know that they then, unfortunately, went on to die whilst in hospital. Therefore, we can have a high degree of confidence in the accuracy of these statistics.

In addition, NHS Trusts are large organisations with teams of staff who are suitably qualified and experienced in collating, validating and submitting data on a daily basis. They have the reporting systems in place and people who are used to operating them in an accurate and timely manner.

The system in care homes is completely different. Firstly, there is no 'chain' to follow, whereby an individual displays severe symptoms, tests positive for the virus, receives medical intervention within a hospital and then, ulimately, dies from the disease. There will, of course, be significant evidence regarding the symptoms suffered by individuals in care homes, but they will be contained within their personal medical records and care plans, which are not routinely reported anywhere (for obvious reasons).

Therefore, we are entirely reliant on the attending doctor who has certified the death. I have absolute confidence in their clinical judgement, which will be based on the individual's recent and underlying medical history, displayed symptoms and progression of disease. Even if we had doubts about the accuracy of the above, the law is clear that a doctor can only certify a death if they have clear clinical evidence of cause of death, and any cases which do not meet that criteria must be reported to the coroner.

It can take several days for a doctor to complete and submit the Medical Certificate of Cause of Death (MCCD). Following receipt of the MCCD, the notifying person (usually the next of kin) has a further nine days to register the death with the Registrar of Births, Deaths and Marriages. This is the reason why the ONS statistics on registered deaths are published two weeks in arrears. Any deaths which have been reported to the coroner cannot be registered until the coroner has concluded their enquiries, which leads to further delays.

The only way in which the system could be speeded up would be, in my opinion, to enable reporting once the MCCD has been issued, rather than waiting for registration of the death to have occured. However, this would require either the attending doctor to submit the information to the DHSC or, alternatively, for the care home themselves to do so.

Both of those systems would have significant problems. If we ask attending doctors (usually GPs) to do it, we would be placing an additional administrative burden on them, at a time when they are already struggling to deliver community based health services and are attending and certifying significantly more deaths than is usual. The data would also require a secondary validation in order to collate place of death in a meaningful, statistical manner which would be an additional burden on GP practices. I am not sure this should be our priority for GPs at this time.

If however, we ask care homes to do it, then this would introduce a whole series of issues. Firstly, do attending doctors routinely share information regarding cause of death with the care home? They may do so informally at times, but can a formal system be introduced which would provide an audit trail for reporting purposes? If such a system is introduced, how would that fit with the doctor's duty to report to the coroner and/or police if they believe that neglect or other action by care home staff may have contributed to the death?

What is the capacity for the care home staff to collate, validate and submit data accurately to the DHSC on a daily basis? How would they deal with the anomalies which invariably occur between one reporting period and the next? As this would be an entirely new administrative system which would require reporting in a uniform manner, what training could be provided duirng a period of social distancing that would enable care home staff to undertake this role in a competent manner? Again, at this point in time, should this be a priority for overstretched care home staff?

In any event, given the usual delay between point of death and the issuing of an MCCD, there would still be a delay of nearly a week (possibly longer if some form a secondary statistical validation is required) before these deaths could be included in the daily figures published by DHSC. My personal view would be that we should wait the additional week and continue to use the ONS publication on registered deaths to capture this information, as this utilises a system which is accurate, well established and well resourced.
 
Six further deaths announced by South Tees NHS Trust, taking total to 106.

No further deaths announced by North Tees and Hartlepool NHS Trust, total remaining at 33.

South Tees NHS Trust are 3rd highest (same as yesterday) in terms of number of deaths in the North East & Yorkshire region (out of 25 NHS Trusts) and the 36th highest (from joint 36th yesterday) in the country (out of 164 NHS Trusts in England).

North Tees and Hartlepool NHS Trust are 17th (same as yesterday) in terms of number of deaths in the North East & Yorkshire region and the 110th (from joint 108th yesterday) in the country.
 
16 further deaths announced by South Tees NHS Trust, taking total to 122.

Seven further deaths announced by North Tees and Hartlepool NHS Trust, taking total to 40.

South Tees NHS Trust are 3rd highest (same as yesterday) in terms of number of deaths in the North East & Yorkshire region (out of 25 NHS Trusts) and the joint 31st highest (from 36th yesterday) in the country (out of 164 NHS Trusts in England).

North Tees and Hartlepool NHS Trust are 18th (from 17th yesterday) in terms of number of deaths in the North East & Yorkshire region and the joint 106th (from 110th yesterday) in the country.
 
How are infections still rising when the lockdown is nearly 3 weeks old?
The percentage rise today is close to, if not the lowest it's been. Some new infections will be NHS staff who are being tested with milder symptoms than most emergency admissions. Will find out later on how bed occupancy is going. It's a shame the UK doesn't report recovered patients as then the hospital admission rate would be known and that most be good news at the moment.
 
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Is it not fair to say that new infections should be in the hundreds and not the thousands? Also are these new infections people who have flouted the lockdown rules?
 
Not if they're NHS staff who have caught it in the line of duty. I have two doctor friends who have both just gone down with Covid-19.

Also we don't know how many are care home infections where infections are increasing significantly.
 
How are infections still rising when the lockdown is nearly 3 weeks old?
I also struggle to understand how the numbers are still going up each day, when by in large the huge majority of the UK population is staying at home, enforcing social distancing and more than likely wearing gloves and a mask when they do infrequently go the shop.

From everything I've read the life cycle of the virus is around 14 days (often less) from initial infection to it passing, so how 3 weeks after lockdown are we still seeing a daily increase. These numbers can't all be attributed to NHS workers, residential care homes etc.
 
I also struggle to understand how the numbers are still going up each day, when by in large the huge majority of the UK population is staying at home, enforcing social distancing and more than likely wearing gloves and a mask when they do infrequently go the shop.

From everything I've read the life cycle of the virus is around 14 days (often less) from initial infection to it passing, so how 3 weeks after lockdown are we still seeing a daily increase. These numbers can't all be attributed to NHS workers, residential care homes etc.
From the Lancet
The study, published in The Lancet, analysed 191 patients with the virus in Wuhan - the area where the virus originated.

The analysis revealed that the virus took between 8 and 37 days to fully shed, with an average viral shedding time of 20 days.

In comparison, the NHS currently suggests that people showing symptoms should self-isolate for just 14 days.

This didn't include incubation period. Clearly this is a small sample for calculating a median but does show a large range.
 
The idea that the mere presence of CoVid-19 "in the area" means the death will be classified as CoVid-19 is without any foundation

The UK's CMO has publicly stated (and did again today) that doctors will register the death as being from Covid-19 if they believe it may have been the cause, regardless of whether the person had a test. Since pneumonia is one of the major causes of death among the elderly, and since the main symptom of Covid-19 is pneumonia I'd have thought it likely doctors in London or other areas with a high incidence of Covid-19 would be tempted to specify a death from pneumonia as suspected Covid-19. They might also add Covid-19 to the death certificate if someone died of heart failure or other causes but had symptoms of Covid-19 even though not tested. They could well be right, but we'll never know. No doubt by years end we'll see that flu deaths have fallen this year, despite this being a bad flu year prior to Covid-19.
 
It's not been a bad flu year prior to Covid-19:

Flu stats for 2019 - 2020

The last weekly report
Flu hospitalisation and intensive care admission rates also decreased from 1.39 per 100,000 to 1.05 per 100,000 and 0.13 per 100,000 to 0.10 per 100,000 respectively – suggesting flu is having a low impact on hospital admissions as well as intensive care unit and high dependency unit admissions.
 
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Saying they're a factory of death is disgusting.
My point is that care home care and management is a global issue, and the number of deaths in these homes is absolutely tragic. In most countries care homes have been locked down for many weeks. This means that any virus in the home must have been introduced by those with a responsibility of care.

In the area I live, one care home has already had 30 deaths. Another more local to me, has 88 residents and staff infected - only three deaths so far, but I fear that will not last. Almost all the local homes (14 of them) have a least one resident or staff member infected. Across multiple countries there are similar accounts.

The irony is that locally care homes are required to have qualified nurses on staff, and those nurses may have been doing double duty in local hospitals due to the pressure on the health service. In doing so they became unwitting vectors for the disease. As well, staff were permitted to work at multiple homes, so have spread the disease from one home to another.

While everyone involved had the best of intentions the combination of understandable ignorance about this virus and a failure of regulations designed to improve care has conspired to create an environment in which there will inevitably be multiple deaths.
 
I found it interesting that a scientist on the BBC earlier this afternoon was able to say 'at the beginning of march covid was the 3rd most noted reason for death but by the last week it was first...'

'what were one and two' asked the presenter.. 'heart disease and dementia' said the scientist who followed by saying there was a significant decrease in heart disease and dementia deaths in the last week of march.

No he did not connect the dots.
 
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